Apnea Of Prematurity, Length Of Stay and NICU Admission in 31-34 Weeks Gestational Age Multiple Births † 994

Introduction: Late preterm infants (LPIs) are infants born between 340/7 and 366/7 weeks gestation. Morbidities in these infants are commonly considered a result of prematurity; however, some research has suggested immaturity may not be the sole cause of morbidities. We hypothesize that antecedents leading to late preterm birth are associated with different patterns of morbidities and that morbidities are the result of gestational age superimposed by the underlying etiologies of preterm delivery. Methods: This is a retrospective cohort study of late preterm neonates born at a single tertiary care center. We examined neonatal morbidities including apnea of prematurity, hyperbilirubinemia, hypoglycemia, and the requirement for continuous positive airway pressure (CPAP). Multivariable logistic regression analysis was performed to estimate the risk of each morbidity associated with 3 categorized antecedents of delivery, that is, spontaneous preterm labor, preterm premature rupture of membranes (PPROM), and medically indicated birth. We calculated the predictive probability of each antecedent resulting in individual morbidity across gestational ages. Results: 279 LPIs were included in the study. Decreasing gestational age was associated with significantly increased risk of apnea of prematurity, hyperbilirubinemia, and requirement of CPAP. In our cohort, the risk of hypoglycemia increased with gestational age, with the greatest incidence at 360−6 weeks. There was no significant association of risk of selected morbidities and the antecedents of late preterm delivery, with or without adjustment for gestational age, multiple gestation, small for gestational age (SGA), antenatal steroids, and delivery method. Discussion and Conclusion: This study found no difference in morbidity risk related to 3 common antecedents of preterm birth in LPIs. Our research suggests that immaturity is the primary factor in determining adverse outcomes, intensified by factors resulting in prematurity.

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Regional variation in cost of neonatal intensive care for extremely preterm infants

BMC Pediatrics ◽

10.1186/s12887-021-02600-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Asaph Rolnitsky ◽

David Urbach ◽

Sharon Unger ◽

Chaim M. Bell

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

Preterm Infants ◽

Gestational Age ◽

Regional Variation ◽

Neonatal Intensive Care ◽

Cost Optimization ◽

Program Cost ◽

Extremely Preterm ◽

Extremely Preterm Infants

Abstract Background Regional variation in cost of neonatal intensive care for extremely preterm infant is not documented. We sought to evaluate regional variation that may lead to benchmarking and cost saving. Methods An analysis of a Canadian national costing data from the payor perspective. We included all liveborn 23–28-week preterm infants in 2011–2015. We calculated variation in costs between provinces using non-parametric tests and a generalized linear model to evaluate cost variation after adjustment for gestational age, survival, and length of stay. Results We analysed 6932 infant records. The median total cost for all infants was $66,668 (Inter-Quartile Range (IQR): $4920–$125,551). Medians for the regions varied more than two-fold and ranged from $48,144 in Ontario to $122,526 in Saskatchewan. Median cost for infants who survived the first 3 days of life was $91,000 (IQR: $56,500–$188,757). Median daily cost for all infants was $1940 (IQR: $1518–$2619). Regional variation was significant after adjusting for survival more than 3 days, length of stay, gestational age, and year (pseudo-R2 = 0.9, p < 0.01). Applying the model on the second lowest-cost region to the rest of the regions resulted in a total savings of $71,768,361(95%CI: $65,527,634–$81,129,451) over the 5-year period ($14,353,672 annually), or over 11% savings for the total program cost of $643,837,303 over the study period. Conclusion Costs of neonatal intensive care are high. There is large regional variation that persists after adjustment for length of stay and survival. Our results can be used for benchmarking and as a target for focused cost optimization, savings, and investment in healthcare.

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Preterm Pulmonary Hemorrhage Is Associated with Multiple Births but Not with Intracytoplasmic Sperm Injection: A Cohort Study on Medical Records

American Journal of Perinatology ◽

10.1055/s-0038-1641589 ◽

2018 ◽

Vol 35 (11) ◽

pp. 1087-1092

Author(s):

Stefanie Stierling ◽

Ralf-Dieter Hilgers ◽

Sonja Trepels-Kottek ◽

Konrad Heimann ◽

Thorsten Orlikowsky ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Gestational Age ◽

Intracytoplasmic Sperm Injection ◽

Medical Records ◽

Ductus Arteriosus ◽

Pulmonary Hemorrhage ◽

Multiple Births ◽

Preterm Neonates ◽

Increased Risk

Objective Pulmonary hemorrhage (PH) is a severe complication in preterm neonates. This study aims to identify risk factors and comorbidities of PH. Study Design A single-center cohort study on medical records including all preterm neonates of <30 weeks' gestational age was conducted in the neonatal intensive care unit of Universitätsklinikum Aachen, Germany. The occurrence of PH served as a primary end point. Gestational age, birthweight, sex, multiple births, intracytoplasmic sperm injection (ICSI), intubation, surfactant, antenatal steroids, intraventricular hemorrhage (IVH), amniotic infection syndrome, and persistent ductus arteriosus were studied as risk factors. Results In this study, 344 preterm neonates were included, of whom 36 suffered from PH (10.5%). The mean time of the first occurrence was the third day of life (standard deviation [SD]: 1.2). On average, the patients suffered from 1.5 incidents (SD: 0.8) of PH, of whom 50% were severe. Preterm neonates born as multiples (95% confidence interval [CI]: 3.1, 26.9) and those who suffered from IVH (95% CI: 2.7, 18.9) had a significantly increased risk of PH. ICSI was not an independent risk factor. Conclusion PH is significantly associated with IVH and multiple births but not with ICSI. The identification of patients at risk allows to apply prophylactic strategies of ventilation and pharmacological treatment.

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Impact of Specialized Nursery Care for Late Preterm Infants on NICU Admission Rate and Length of Stay

American Journal of Perinatology ◽

10.1055/s-0035-1552938 ◽

2015 ◽

Vol 32 (13) ◽

pp. 1198-1204 ◽

Cited By ~ 2

Author(s):

Gene Hallford ◽

Candace Robledo ◽

Edgardo Szyld ◽

Clara Song ◽

Laura Hunt

Keyword(s):

Length Of Stay ◽

Preterm Infants ◽

Admission Rate ◽

Late Preterm ◽

Late Preterm Infants ◽

Nicu Admission

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Discharging Preterm Infants Home on Caffeine, a Single Center Experience

Children ◽

10.3390/children7090114 ◽

2020 ◽

Vol 7 (9) ◽

pp. 114

Author(s):

Cheng Ma ◽

Denisse Broadbent ◽

Garrett Levin ◽

Sanjeet Panda ◽

Devaraj Sambalingam ◽

...

Keyword(s):

Length Of Stay ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Preterm Neonates ◽

Single Center Experience ◽

Lack Of Information ◽

Almost All ◽

Prolonged Hospital ◽

Apnea Of Prematurity ◽

At Home

Background: Apnea of prematurity (AOP) affects preterm neonates. AOP, combined with intermittent hypoxemic (IH) events frequently prolongs the length of stay. Caffeine is the preferred medication to treat AOP and may help improve IH events. There is lack of information on the safety of discharging preterm neonates home on caffeine for AOP in the literature. Our objective was to assess safety and benefits, if any, of discharging preterm infants home on caffeine. Methods: After IRB approval, preterm infants discharged home from the neonatal intensive care unit (NICU) on caffeine were compared with those without a discharge prescription for the period of January 2013 to December 2017. Results: A total of 297 infants were started on caffeine, and of those, 87 infants were discharged home on caffeine. There was no difference in length of stay between two groups. Duration of caffeine at home was 31 (28–42) days. The average cost of apnea monitor and caffeine at home per 30 days was USD 1326 and USD 50. There was no difference in number or reasons for emergency department (ED) visits or hospitalizations between two groups. Conclusion: AOP affects almost all preterm infants and along with intermittent hypoxemic events, and is one of the most common reasons for prolonged hospital stay. Discharging stable preterm infants home on caffeine may be safe, especially in those who are otherwise ready to be discharged and are only awaiting complete resolution of AOP/IH events.

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Grief in Multifetal Death

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000004104 ◽

1988 ◽

Vol 37 (2) ◽

pp. 181-185 ◽

Cited By ~ 4

Author(s):

Mary Kay Sainsbury

Keyword(s):

Case Studies ◽

Gestational Age ◽

Unique Feature ◽

Higher Order ◽

Large Percentage ◽

Multiple Births ◽

Grieving Process ◽

Grief Process ◽

The Individual ◽

Multifetal Pregnancy

AbstractThe grief process is examined within the framework of multifetal pregnancy in a variety of demise situations. The case studies examined were obtained from approximately 120 lettere and interviews with families predominantly of higher order multiple births, who have experienced either partial or total loss in their pregnancy or afterwards. Objective and subjective factors were addressed. Results indicate the steps of the grief response are worked through in the same order as a singleton demise, but differ in intensity, duration, and frequency, depending on the individual circumstances, type of loss, gestational age, and the parents' backgrounds, expectations and beliefs. A unique feature discovered is that the entire grieving process, from shock through acceptance, appears to be completely experienced twice, with a large percentage of parents experiencing all of the stages three or more times. The general conclusion of the study is that the grieving pattern in multifetal death indeed follows a cycle and pattern of its own and requires special considerations.

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Resolution of Apnea of Prematurity (AOP) in 24-28 Week Gestational Age (GA) Infants Is No Different from Preterms 31-34 Weeks GA

Pediatric Research ◽

10.1203/00006450-199904020-01497 ◽

1999 ◽

Vol 45 (4, Part 2 of 2) ◽

pp. 251A-251A

Author(s):

Nwanneka Nwokolo ◽

Mara Nitu ◽

Susan Katz ◽

Joseph D DeCristofaro

Keyword(s):

Gestational Age ◽

Apnea Of Prematurity

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Which growth standards should be used to identify large- and small-for-gestational age infants of mothers with type 1 diabetes? A pre-specified analysis of the CONCEPTT trial

10.21203/rs.3.rs-27918/v2 ◽

2020 ◽

Author(s):

Claire L Meek ◽

Rosa Corcoy ◽

Elizabeth Asztalos ◽

Laura Caroline Kusinski ◽

Esther Lopez ◽

...

Keyword(s):

Type 1 Diabetes ◽

Fetal Growth ◽

Gestational Age ◽

Small For Gestational Age ◽

Perinatal Outcomes ◽

Neonatal Hypoglycaemia ◽

Growth Standards ◽

Who Standards ◽

Nicu Admission

Abstract Background Offspring of women with type 1 diabetes are at increased risk of accelerated fetal growth which is associated with perinatal morbidity. Growth standards are used to identify large- or small- for gestational age (LGA, SGA) infants. Our aim was to examine which growth standards identify infants at risk of perinatal complications during the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT). Methods This was a pre-specified analysis of CONCEPTT involving 225 pregnant women from 31 international centres. Infants were weighed immediately at birth and GROW, INTERGROWTH and WHO centiles calculated. Unadjusted logistic regression identified the associations between different growth standards and perinatal outcomes including preterm delivery, Caesarean delivery, neonatal hypoglycaemia, hyperbilirubinaemia, respiratory distress, neonatal intensive care unit (NICU) admission and a composite neonatal outcome. Results Accelerated fetal growth was common, with mean birthweight percentiles of 82.1, 85.7 and 63.9 and LGA rates of 62%, 67% and 30% using GROW, INTERGROWTH and WHO standards respectively. Corresponding rates of SGA were 2.2%, 1.3% and 8.9% respectively. All standards were associated with some but not all perinatal outcomes studied. Infants born >97.7 th centile were at highest risk of complications. Conclusions WHO standards underestimated birthweight centile. GROW and INTERGROWTH standards identified similar numbers of infants as LGA and SGA with GROW showing stronger associations with neonatal hypoglycaemia, hyperbilirubinaemia and NICU admission. Infants with suspected birthweight >97.7th centile according to any standard may require extra surveillance. Definitions of LGA and SGA should be re-evaluated in diabetic pregnancy.

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Fetal and maternal outcome in oligohydramnios pregnancy (37-40 weeks)

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210312 ◽

2021 ◽

Vol 10 (2) ◽

pp. 605

Author(s):

Suyajna D. Joshi ◽

Ruksar Banu ◽

Rajeswari Rai ◽

Jayasakthi G.

Keyword(s):

Gestational Age ◽

District Hospital ◽

Fetal Distress ◽

Pregnancy Complication ◽

High Rate ◽

Age Group ◽

Intrapartum Care ◽

Careful Evaluation ◽

Fetal Surveillance ◽

Nicu Admission

Background: This study is conducted to see the effects of oligohydramnios on both mother and fetus.Methods: 237 antenatal patients delivered at Department of DNB-OBG District hospital Bellari during January 2018 to December 2018 with gestational age between 37-40wks with AFI<5cms with intact membranes were studied and analyzed retrospectively for perinatal and maternal outcome.Results: Out of 237 cases with oligohydramnios with AFI <5cm studied, about 229 cases underwent LSCS (96.6%). most are primigravida about 164(69.19%), belong to age group of <25 about 181(76%). Average gestational age noted to be 38+4 weeks about 55.9% (132), NICU admission seen in 47(19.8%) of total cases. Most of the babies delivered are >2.5 kg birth weight about 144 (60.75%) of cases. New born with APGAR <7 @ 1 min seen in 36 cases (15.15%). Meconeum stained liquor seen in about 70 cases (29.5%).Conclusions: Oligohydramnios has significant correlation with increased Caesarean section for fetal distress. Oligohydramnios is associated with high rate of pregnancy complication and increased rate of NICU admission. Oligohydramnios is a frequent occurrence demanding careful evaluation, intensive fetal surveillance and proper antepartum and intrapartum care.

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Maternal risk factors and immediate outcome of late preterms

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20193598 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1845

Author(s):

Sahana Giliyaru ◽

Sahaya Nirmala S. ◽

Adarsh E.

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Gestational Age ◽

Mode Of Delivery ◽

Late Preterm ◽

Close Monitoring ◽

Maternal Risk Factors ◽

Maternal Risk ◽

Preterm Babies ◽

Nicu Admission

Background: This study was conducted to analyse the immediate outcome of late preterm babies and also to evaluate the various maternal risk factors in these babies so that close monitoring of these babies for the complications is done and immediate problems can be addressed.Methods: Prospective observational study done in level 3 NICU setting for 6 months. All babies born between 34-36/7 weeks are included in the study and they constitute the cases. Term (above 36 weeks 6 days gestation) newborns babies born during the study period are controls. Maternal history is taken in detail. Risk factors during pregnancy including maternal age, gravida, mode of delivery, medical conditions and birth details. Baby details like gestational age, sex, birth weight, and neonatal morbidities are recorded. The babies are either shifted to NICU or to mother’s side based depending on the baby’s condition. All of them are followed up till discharge.Results: 89 late preterm babies born in the hospital during the study period are included in the study. Out of 89 babies 45are females constituting 50.6% and 44are male babies constituting 49.4%. 20 (22.5%) babies had gestational age between 34-35 weeks.29 babies (32.5 %) had gestational age between 35-36 weeks and 40 babies (45%) are between 36-37 weeks of gestation. 47 babies (52.9%) have birth weight between 1.5-2.49 kg.42 babies (47.1%) have birth weight between 2.5-3.5 kg. The number of babies born by LSCS were 48 (54%) and 41 babies 46% are born through vaginal route.42 babies constituting 48.3% are appropriate for gestational age and 43 babies (49.4%) are small for gestationalage.34 (39.1%) babies required NICU admission and 55 (60.9%) babies did not require NICU admission. Among the maternal risk factors PIH was the commonest risk factor in 22babies (24.7 %), followed by PROM13 (14.6 %), oligohydramnios 6 (6.7 %) ,twin gestation 6 (6.7 %), MSAF 3 (3.4%), IDM 3 (3.4%), Antepartum hemorrhage 3 (3.4%), eclampsia 1 (1.1%) and maternal cardiac disease 1.1%. Neonatal morbidities are 25 late preterm babies had jaundice (28.7%) followed by RDS in 15 (17.2%), sepsis in 9 (10.3%), NEC 2 (2.3%), Hypoglycemia 5 (5.6%) late preterm babies required ventilation/ CPAP constituting 5.7%. Surfactant was used in 2 late preterm babies 2.3%. 87 babies (97.8%) got discharged and mortality is 2.2%.Conclusions: Late prematurity is associated with significant neonatal morbidity.

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